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Nations in transition from totalitarian rule, mainly under the aegis of the former USSR, to liberal democracy. Many such nations have had unfavorable mortality trends since the late 1980s: the trends for premature mortality among males have been among the least favorable in the world. In Russia in the late 1990s, there were 2.5 million excess male deaths compared with the already elevated rates of 1991. Cardiovascular disease and violence were the largest contributors to excess mortality. There was a widespread failure to develop effective control programs for chronic diseases and for injury and violence, often associated with excessive alcohol use.